A review on antimicrobial strategies in mitigating biofilm-associated infections on medical implants

Biomedical implants are crucial in providing support and functionality to patients with missing or defective body parts. However, implants carry an inherent risk of bacterial infections that are biofilm-associated and lead to significant complications. These infections often result in implant failure, requiring replacement by surgical restoration. Given these complications, it is crucial to study the biofilm formation mechanism on various biomedical implants that will help prevent implant failures. Therefore, this comprehensive review explores various types of implants (e.g., dental implant, orthopedic implant, tracheal stent, breast implant, central venous catheter, cochlear implant, urinary catheter, intraocular lens, and heart valve) and medical devices (hemodialyzer and pacemaker) in use. In addition, the mechanism of biofilm formation on those implants, and their pathogenesis were discussed. Furthermore, this article critically reviews various approaches in combating implant-associated infections, with a special emphasis on novel non-antibiotic alternatives to mitigate biofilm infections.

Atomic Layer Deposition of Antibacterial Nanocoatings: A Review

In recent years, antibacterial coatings have become an important approach in the global fight against bacterial pathogens. Developments in materials science, chemistry, and biochemistry have led to a plethora of materials and chemical compounds that have the potential to create antibacterial coatings. However, insufficient attention has been paid to the analysis of the techniques and technologies used to apply these coatings. Among the various inorganic coating techniques, atomic layer deposition (ALD) is worthy of note. It enables the successful synthesis of high-purity inorganic nanocoatings on surfaces of complex shape and topography, while also providing precise control over their thickness and composition. ALD has various industrial applications, but its practical application in medicine is still limited. In recent years, a considerable number of papers have been published on the proposed use of thin films and coatings produced via ALD in medicine, notably those with antibacterial properties. The aim of this paper is to carefully evaluate and analyze the relevant literature on this topic. Simple oxide coatings, including TiO2, ZnO, Fe2O3, MgO, and ZrO2, were examined, as well as coatings containing metal nanoparticles such as Ag, Cu, Pt, and Au, and mixed systems such as TiO2-ZnO, TiO2-ZrO2, ZnO-Al2O3, TiO2-Ag, and ZnO-Ag. Through comparative analysis, we have been able to draw conclusions on the effectiveness of various antibacterial coatings of different compositions, including key characteristics such as thickness, morphology, and crystal structure. The use of ALD in the development of antibacterial coatings for various applications was analyzed. Furthermore, assumptions were made about the most promising areas of development. The final section provides a comparison of different coatings, as well as the advantages, disadvantages, and prospects of using ALD for the industrial production of antibacterial coatings.

Evaluation on the possibility of sound conduction independent of tympanic air cavity for severe tympanic adhesion patients by finite element analysis

Background: For patients with severe tympanic adhesion, reconstructing the tympanic air cavity is often challenging, resulting in poor hearing reconstruction outcomes. Therefore, establishing a sound conduction pathway independent of the tympanic air cavity may be a viable method for reconstructing hearing in these patients. Purpose: The objective of this study was to evaluate the feasibility of sound conduction independent of the tympanic air cavity (i.e., replacing the original cavity with a tympanic vibrating material) using finite element analysis. Methods: We established a sound-structure coupling finite element model of the tympanum vibration conduction system, which included the tympanic membrane (TM), ossicular prosthesis, and tympanic vibrating material. This model was used to simulate middle ear vibrations under sound pressure, and we extracted the frequency response curve of the ossicular prosthesis' vibration displacement amplitude to evaluate the sound conduction effect of the middle ear. Next, we adjusted the structural and mechanical parameters of the tympanic vibrating material to analyze its impact on the sound conduction effect of the middle ear. Finally, we compared the frequency response curve of the stapes footplate in normal subjects to evaluate the feasibility of sound conduction independent of the tympanic air cavity. Results: The Shell tympanic vibrating material had a better vibration conduction effect compared to solid or porous tympanic vibrating material. The vibration amplitude decreases with the increasing elastic modulus of the tympanic vibrating material. Implantation of 40 kPa-shell tympanic vibrating material had the lowest hearing loss less than 5 dB, and the hearing loss with 1 MPa-porous tympanic vibrating material was largest and less than 25 dB. Conclusion: Our study suggests that replacing the tympanic air cavity with a tympanic vibrating material is feasible. The establishment of a sound conduction pathway independent of the tympanic air cavity could potentially provide a method for hearing reconstruction in patients with severe tympanic adhesion.

Transparent neural interfaces: challenges and solutions of microengineered multimodal implants designed to measure intact neuronal populations using high-resolution electrophysiology and microscopy simultaneously

The aim of this review is to present a comprehensive overview of the feasibility of using transparent neural interfaces in multimodal in vivo experiments on the central nervous system. Multimodal electrophysiological and neuroimaging approaches hold great potential for revealing the anatomical and functional connectivity of neuronal ensembles in the intact brain. Multimodal approaches are less time-consuming and require fewer experimental animals as researchers obtain denser, complex data during the combined experiments. Creating devices that provide high-resolution, artifact-free neural recordings while facilitating the interrogation or stimulation of underlying anatomical features is currently one of the greatest challenges in the field of neuroengineering. There are numerous articles highlighting the trade-offs between the design and development of transparent neural interfaces; however, a comprehensive overview of the efforts in material science and technology has not been reported. Our present work fills this gap in knowledge by introducing the latest micro- and nanoengineered solutions for fabricating substrate and conductive components. Here, the limitations and improvements in electrical, optical, and mechanical properties, the stability and longevity of the integrated features, and biocompatibility during in vivo use are discussed.

Preventing Biofilm Formation and Development on Ear, Nose and Throat Medical Devices

Otorhinolaryngology is a vast domain that requires the aid of many resources for optimal performance. The medical devices utilized in this branch share common problems, such as the formation of biofilms. These structured communities of microbes encased in a 3D matrix can develop antimicrobial resistance (AMR), thus making it a problem with challenging solutions. Therefore, it is of concern the introduction in the medical practice involving biomaterials for ear, nose and throat (ENT) devices, such as implants for the trachea (stents), ear (cochlear implants), and voice recovery (voice prosthetics). The surface of these materials must be biocompatible and limit the development of biofilm while still promoting regeneration. In this respect, several surface modification techniques and functionalization procedures can be utilized to facilitate the success of the implants and ensure a long time of use. On this note, this review provides information on the intricate underlying mechanisms of biofilm formation, the large specter of implants and prosthetics that are susceptible to microbial colonization and subsequently related infections. Specifically, the discussion is particularized on biofilm development on ENT devices, ways to reduce it, and recent approaches that have emerged in this field.

Atomic layer deposition on dental materials: Processing conditions and surface functionalization to improve physical, chemical, and clinical properties - A review

Surface functionalization is an effective approach to improve and enhance the properties of dental materials. A review of atomic layer deposition (ALD) in the field of dental materials is presented. ALD is a well-established thin film deposition technique. It is being used for surface functionalization in different technologies and biological related applications. With film thickness control down to Ångström length scale and uniform conformal thin films even on complex 3D substrates, high quality thin films and their reproducibility are noteworthy advantages of ALD over other thin film deposition methods. Low temperature ALD allows temperature sensitive substrates to be functionalized with high quality ultra-thin films too. In the current work, ALD is elaborated as a promising method for surface modification of dental materials. Different aspects of conventional dental materials that can be enhanced using ALD are discussed. Also, the influence of different ALD thin films and their microstructure on the surface properties, corrosion-resistance, antibacterial activity, biofilm formation, and osteoblast compatibility are addressed. Depending on the stage of advancement for the studied materials reported in the literature, these studies are then categorized into four stages: fabrication & characterization, in vitro studies, in vivo studies, and human tests. Materials coated with ALD thin films with potential dental applications are also presented here and they are categorized as stage 1. The purpose of this review is to organize and present the up to date ALD research on dental materials. The current study can serve as a guide for future work on using ALD for surface functionalization and resulting property tuning of materials in real world dental applications.

A case report of a cochlear implant infection - A reason to explant the device?

CLINICAL PRESENTATION

Case history of a paediatric patient with a cochlear implant and a surgical site infection that developed as a result of acute otitis media is presented.

INTERVENTION

After conservative management including wound debridement it was decided to explant a functioning device.

OBJECTIVE AND IMPORTANCE

In a number of cases, it is necessary to remove the infected albeit functioning device, especially in the event of formation of the biofilm has occurred. It is necessary to review and evaluate the methods with which these major complications are routinely managed with the aim to increase the survival ratio for the implanted device.

Relationships among growth mechanism, structure and morphology of PEALD TiO2 films: the influence of O2 plasma power, precursor chemistry and plasma exposure mode

Titanium dioxide (TiO2) thin films have generated considerable interest over recent years, because they are functional materials suitable for a wide range of applications. The efficient use of the outstanding functional properties of these films relies strongly on their basic characteristics, such as structure and morphology, which are affected by deposition parameters. Here, we report on the influence of plasma power and precursor chemistry on the growth kinetics, structure and morphology of TiO2 thin films grown on Si(100) by plasma-enhanced atomic layer deposition (PEALD). For this, remote capacitively coupled 13.56 MHz oxygen plasma was used to act as a co-reactant during the ALD process using two different metal precursors: titanium tetrachloride (TiCl4) and titanium tetraisopropoxide (TTIP). Furthermore, we investigate the effect of direct plasma exposure during the co-reactant pulse on the aforementioned material properties. The extensive characterization of TiO2 films using Rutherford backscattering spectroscopy, ellipsometry, x-ray diffraction (XRD), field-emission scanning electron microscopy, and atomic force microscopy (AFM) have revealed how the investigated process parameters affect their growth per cycle (GPC), crystallization and morphology. The GPC tends to increase with plasma power for both precursors, however, for the TTIP precursor, it starts decreasing when the plasma power is greater than 100 W. From XRD analysis, we found a good correlation between film crystallinity and GPC behavior, mainly for the TTIP process. The AFM images indicated the formation of films with grain size higher than film thickness (grain size/film thickness ratio ≈20) for both precursors, and plasma power analysis allows us to infer that this phenomenon can be directly related to the increase of the flux of energetic oxygen species on the substrate/growing film surface. Finally, the effect of direct plasma exposure on film structure and morphology was evidenced showing that the grid removal causes a drastic reduction in the grain size, particularly for TiO2 synthesized using TiCl4.

Introducing a semi-coated model to investigate antibacterial effects of biocompatible polymers on titanium surfaces

Peri-implant infections from bacterial biofilms on artificial surfaces are a common threat to all medical implants. They are a handicap for the patient and can lead to implant failure or even life-threatening complications. New implant surfaces have to be developed to reduce biofilm formation and to improve the long-term prognosis of medical implants. The aim of this study was (1) to develop a new method to test the antibacterial efficacy of implant surfaces by direct surface contact and (2) to elucidate whether an innovative antimicrobial copolymer coating of 4-vinyl-N-hexylpyridinium bromide and dimethyl(2-methacryloyloxyethyl) phosphonate (VP:DMMEP 30:70) on titanium is able to reduce the attachment of bacteria prevalent in peri-implant infections. With a new in vitro model with semi-coated titanium discs, we were able to show a dramatic reduction in the adhesion of various pathogenic bacteria (Streptococcus sanguinis, Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis), completely independently of effects caused by soluble materials. In contrast, soft tissue cells (human gingival or dermis fibroblasts) were less affected by the same coating, despite a moderate reduction in initial adhesion of gingival fibroblasts. These data confirm the hypothesis that VP:DMMEP 30:70 is a promising antibacterial copolymer that may be of use in several clinical applications.